There are no randomized-controlled studies that examine the effectiveness of VTE prophylaxis in debilitated patients following discharge from the hospital, and currently the literature does not recommend prophylaxis for chronic immobility as a single risk factor for VTE (1). However, given the expected morbidity, potential mortality and hospital readmission associated with VTE, prophylaxis should be considered in residents of LTFs with the following comorbidities (2):
- Acute exacerbation of congestive heart failure
- Acute exacerbation of chronic obstructive pulmonary disease
- Acute infection (e. g. pneumonia, urosepsis, skin and soft tissue infections, infectious diarrhea)
- Acute exacerbation of inflammatory/autoimmune diseases
- Active malignancy
- Immobility and prior VTE
Unless contraindicated, patients should receive prophylactic doses of unfractionated heparin, enoxaparin, or other approved drugs. Mechanical VTE prophylaxis should be used only when the risk of bleeding is considered unacceptably high or when there are drug intolerances or adverse effects.
The need for VTE prophylaxis should be reassessed regularly taking into account patient’s overall health status, mobility, drug tolerance and goals of care.
References
- Pai M, Douketis JD. Preventing venous thromboembolism in long-term care residents: Cautious advice based on limited data. Cleveland Clin J Med 2010;77: 123-130. https://www.ncbi.nlm.nih.gov/pubmed/20124270
- Robinson Am. Venous thromboembolism prophylaxis for chronically immobilized long-term care residents. Ann Long-Term Care 2013;10:30. https://www.managedhealthcareconnect.com/article/venous-thromboembolism-prophylaxis-chronically-immobilized-long-term-care-residents
